new model of master of philosophy in physiological sciences

The objectives of Master of Philosophy [MPhil] in Physiological Sciences are: 1] to describe the new ways in which anatomy, biochemistry and physiology on one hand, and microbiology, pathology and pharmacology on other hand meet their functional requirements through multidisciplinary integrated concepts; 2] to elucidate relationships between cell biology, molecular biology and molecular genetics by connecting dots of how cell functions are driven by molecules and being controlled by genes. This forms the basis of cell, molecular and genetics [CMG] module upon which 7 multidisciplinary modules of Physiological Sciences follow; 3] these 24 credit hours provide the physiological basis for PhD studies as well as faculty development to enhance learning abilities of medical student; 4] the modules constitute Cardio- Respiratory Physiological Sciences, GI and Renal Physiological Sciences, Neurosciences, Endo-Reproductive Physiological Sciences.; 5] it has integrated microbiology, pathology and pharmacology in a unique way through CMG of microbes leading to associated pathology and mechanisms of prescribed drugs; 6] it has additional synopsis and thesis friendly course work leading to comprehensive examinations; 7] the year two deals with research work of 6 credit hours leading to defense of thesis; 8] The MPhil in Physiological Sciences is fundamentally different from what is being offered elsewhere. It prepares and offers a good spring board to dovetail PhD studies as well as faculty and institutional development. This is the first study that deals with innovative programmes in research, learning and education in the field of physiological sciences. This broad-based MPhil would make its recipients competent, critical, confident and productive learner. This is a completely unique design of a curriculum that has no comparable examples elsewhere. Our mission is to educate graduate students in the field of Physiological Sciences such that they have a complete grasp over the broad-based integrated concepts of basic health sciences. Upon completion of their education, the students will be able to use the duality of imagination and skepticism. Hence, the students will contribute to their fields by unfolding their creative energy

Influence of tourniquet application; on selected chemical analytes

The objective of the study was to determine the mean change in selected chemical analytes with and without application of tourniquet. Blood samples were collected from all persons irrespective of age and gender visiting pathology laboratory, Quaid-e-Azam Medical College, Bahawalpur. The study was a Quasi experimental study. The study was carried out in Pathology Laboratory, Quaid-e-Azam Medical College, Bahawalpur on Selectra XL and Easy lyte. October 2011 to April 2012. Blood samples were taken from both arms of 265 volunteer with one difference that standardized external pressure of 60 mm Hg was applied by using a sphygmomanometer for one minute on one arm and on other arm blood sample was collected without application of tourniquet. Samples with tourniquet application showed statistically significant mean increase in serum concentration of protein [p =0.001], cholesterol [p=0.03], calcium [p =0.007] and potassium [p=0.0001]. The mean concentration of serum sodium and chloride showed no statistically significant change after one minute of tourniquet application. The tourniquet application of one minute influence certain laboratory parameters, so its use should be kept to a minimum

Endoscopic Findings of Patients Reporting With Upper Gastrointestinal Symptoms - A Study of 1493 Cases

OBJECTIVE: Endoscopic findings of patients reporting with upper gastrointestinal symptoms

STUDY DESIGN: A retrospective observational study

PLACE AND DURATION: Shaukat Omar Memorial Fauji Foundation Hospital, Karachi and Khan Diagnostic Laboratories, Malir Karachi from January 2001 to May 2010

METHODS: All the consecutive cases that underwent upper gastrointestinal endoscopic examination during January 2001 to May 2010 were included in the study. The computerised data of these cases was retrieved from hospital record. The cases were thoroughly reviewed regarding their history, examination, investigations and findings of the endoscopy. Patients with known gall bladder and pancreatic diseases and advanced malignancies were excluded. Results were compiled and statistically analysed using SPSS v.16

RESULTS: A total of 1493 patient were included. Male to female ratio was 1.4:1. Mean age was 44.38+13.52 years. The common indications were dyspepsia, dysphagia and haemtemesis. Four hundred and thirteen [27.7%] endoscopies were normal. The common pathological findings were Oesophagitis 25%, duodenal ulcer 12.9%, Gastritis 11.7%, gastric ulcer 8.4%, esophageal malignancies 4.5%, gastric malignancies 4.3% others i.e. less common findings [oesophageal web, oesophageal stricture, oesophageal varices, oesphageal candidiasis, achalasia etc] were 5.5%

CONCLUSION: Upper GI endoscopy is an important diagnostic tool for patients of upper GI symptoms to differentiate pathological from non-ulcer dyspepsia. Upper GI endoscopy is recommended in all cases of dyspepsia to evaluate the actual pathology

Pattern of injuries in trauma patients presenting in accident and emergency department of Jinnah Hospital, Lahore

To observe the pattern of injuries in patients involved in different kinds of trauma presenting to the Accident and Emergency Department of Jinnah Hospital Lahore. A prospective descriptive epidemiological study. Accident and emergency department of Jinnah Hospital Lahore. From 1st April 2005 to 30th September 2005. The study included patients presenting with different kinds of trauma to the emergency department of Jinnah Hospital, Lahore. They were further categorized into trauma of different regions of the body i.e. upper limb, lower limb, abdomen, head and neck, thorax and perineum. Then frequency of different types of trauma was determined. During this period [1st April2005 to 30th September 2005], 111'413 patients presented in accident and emergency department and 4680 patients had traumatic injury. 1404 patients [30%] had blunt trauma, 134[2.86%] had penetrating firearms injury, 2433[51.99%] had penetrating sharp injury an d 709 patients [15.15%] had crush injury. Most patients got upper limb, lower limb, head and neck and abdominal injuries, in that order. Most patients received multiple injuries. 3340 patients [71.36%] got only minor surgery like stitching under local anaesthesia and 468 patients [10%] had no surgery at all. 872 patients [18.63%] underwent some kind of major surgical procedure like amputation, exploratory laparotomy, or stitching under GA etc. Trauma is a leading cause of morbidity and mortality among all age groups. Most of the trauma victims receiving minor injuries can be treated at primary heath care centers. This can decrease the load of tertiary care hospitals. Maximum impact in reducing the burden of trauma must come from injury prevention strategies

Ivor Lowis esophagectomy: experience at Jinnah hospital, Lahore

Although different approaches have been used for surgical resection of esophageal cancer, the Ivor Lewis approach is the standard technique at most centers for resection of the diseased middle and lower third esophagus. This procedure has historically been associated with significant morbidity and mortality. However, modern literature suggests that Ivor Lewis esophagectomy can be performed with an acceptable complication rate and mortality. Patients and methods: We conducted a case series of thirteen consecutive patients who underwent an Ivor Lewis esophagectomy at Jinnah Hospital Lahore from January, 2001 to December, 2002. The objective was to examine the morbidity, mortality and short-term outcome of this surgical procedure. The mean age of the patients was 45.9 years +/- 18.3 years [median: 44.5 years; range: 22 to 78 years]. 7 patients were men and 6 patients were women. 6 patients [46.2%] were operated for benign corrosive esophageal strictures whereas seven patients [63.8%] had esophageal cancer. The median age of the patients with benign strictures was 28 years [range: 20 - 35 years]. The median age of the cancer patients was 58 years [range: 54-70 years]. Of these patients, one had Stage I cancer [9.29%], two had Stage II a [28.57%], two had Stage II b [28.57%], and two had Stage III disease [28.57%]. Five patients [71.42%] had adenocarcinoma and two [28.57%] had squamous cell carcinoma. Seven patients [53.8%] had one or more co-morbid conditions, including diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease. Four patients [30.77%] had history of smoking. The mean operative time was 270 minutes +/- 31 minutes. The mean operative blood loss was 1500 ml +/- 102 ml. The median ICU stay was one day [range: I to 7 days]. The median hospital stay was 19 days [range: 15 to 38 days]. Eight patients [61.54%] developed post-operative complications. Most of these complications were medical [60%] rather than surgical [40%]. Respiratory complications were the commonest [30.77%]. Of the surgical complications, the most common was the development of an anastomotic leak [23.08%]. All of these were managed conservatively and none proved fatal. There were two mortalities on post operative days 7 and 8, due to ARDS and multi-organ failure respectively. The operative mortality was 15.39%.Ivor Lewis esophagectomy represents a major physiological and surgical insult. However, careful patient selection, perioperative monitoring and early aggressive treatment of complications can significantly reduce morbidity and mortality

Is breast cancer in younger women a more aggressive variant? a comparative study

Breast cancer is the commonest malignancy in women in the world. About 5% of all breast cancer patients are 35 years old or younger. Current literature suggests that breast cancer in these younger women may be different in etiology, clinical features and outcome from the disease seen in older women. We included all breast cancer patients who underwent surgical treatment at Surgical Unit IV, Jinnah hospital, Lahore from December, 1998 to December, 2003. All patients who left against medical advice or were lost to follow up before completing treatment at our hospital wee excluded. The patients were divided into two groups by age. Those who were 35 years old or younger were placed in group 1 [88 patients] and those older than 35 years were placed in group 11[54 patients], which served as the control group. We compared the clinical presentation, the risk factor profile, and the grade and the stage of the tumor at presentation in younger women and their older controls. The mean age in group I was 29.38 years +/- 3.68 years. While the mean age in group II was 44.41 years +/- 7.64 years. The commonest mode of presentation in both groups was a painless lump. [93.2% in group I and 66.67% in group II; p value < 0.001]. The distribution of classical risk factors was similar in the two groups. These included family history [12.5% in group I and 11.1% in group II], nulliparity [7.95% in group I and 7.4% in group II], and oral contraceptives use[14.77% in group I and 12.96% in group II]. Younger patients presented with a greater number of poorly differentiated [Grade III] tumors compared to the older patients. [73.76% vs.24.07%; p value <0.001]. They also presented more frequently with hormone insensitive tumors [79.55% in group I vs. 24.52% in group II; p value < 0.001]. Mammography was positive more often in older women compared to the younger ones [97.44% vs.41.38%; p value < 0.001]. Ultrasound was done in 67.05% of the younger women and 27.78% in the older women. It was suggestive of malignancy in 89.83% of the younger women and 86.67% of the older ones. Modified radical mastectomy was done in 75% of the younger patients [Group I] and 61.11% of the older patients [Group II]. Radical mastectomy was done in 19.32% of group I patients and 27.78% of group II patients. Older women underwent breast conservation treatment more often than the younger women [11.11% vs. 5.68%; p value < 0.05] Adjuvant chemotherapy was given more often to younger women [73.86% in group I vs. 9.26% in group II; p value < 0.0001]. On the other hand, older patients received hormonal therapy more often that the younger ones [74.07% vs. 20.45%; p value < 0.001]. Younger patients also received adjuvant radiotherapy more frequently than their older counterparts [84.32% vs. 49.26; p value <0.05]. We conclude that women with breast cancer who are 35 years old or younger have more aggressive tumors than the older patients i.e. they present at a higher stage with poorly differentiated tumors that are frequently hormone insensitive

Incidence of urinary tract infection during pregnancy

Incidence of urinary tract infection [UTI] during pregnancy among Pakistani women was examined. Midstream urine was collected from 250 pregnant and 100 control women and streaked on blood agar and incubated. Growth was considered significant if > / = 10[5]/mL bacteria were present. Among the pregnant women, 28.5% had UTI; 30.0% of controls had UTI. Among the pregnant and control women, 24.4% and 20.0% respectively had UTI symptoms, such as incontinence, nocturia and urgency. Symptoms did not correlate with incidence. Socioeconomic status, personal hygiene, education level, pregnancy duration, postcoital washing, contraceptive use and use of underclothing had no significant association with UTI occurrence. A history of past urological problems was associated with an increased incidence of UTI in pregnancy

Liver abscess: presentations and management

The clinical and management data of 19 patients,who reported to surgical unit2 of Sir Ganga Ram Hospital, Lahore with liver abscesses are presented. These patients were treated with, percutaneous drainge under Ultrasound control with the help of Radiology Department. In 11 patients[57.9%] No. 16 size needle was used while in 8 cases [42.1%] size 26 F Foley's Catheter was used.In 16 cases [84.2%] abscesses were in right lobe, in 1 patient [5.3%] left lobe and 2 patients [10.4%] had multiple abscesses of liver. There was one morfafity.[5.3%] and 3 patients [15.8%] showed post operative complications. Results show that percutaneous drainge is safe and effective procedure with low morbidity and negligible mortality

Helicobacter pylori infection- different methods of identification

The diagnostic yield of histology rapid urease test and culture was assessed for the detection of Helicobacter pylori [H. Pylori] infection in patients undergoing gastroscopy for dyspeptic symptoms. Histology was positive for H. Pylori in 80%, rapid urease in 63%, and culture in only 23% of cases